Next-generation sequencing guides the treatment of severe community-acquired pneumonia with empiric antimicrobial therapy failure: A propensity-score-matched study

by Yuhao Zhao, Yajuan Wang, Yi Li, Chao Song, Pinhua Pan

Background

Next-generation sequencing (NGS) is a promising diagnostic tool for pathogens diagnosis. The aim of this study is to evaluate the application of NGS-based antimicrobial therapy on clinical outcomes in severe community-acquired pneumonia (SCAP) patients with empiric antimicrobial therapy failure.

Methodology

We performed a multi-center, retrospective cohort of SCAP patients with initial empiric therapy failure. Propensity score (PS) matching was used to obtain balance among the baseline variables in NGS group (n = 82) and conventional group (n = 82). We compared the diagnostic performance of NGS with conventional microbial culture. We also compared the impact of NGS-based antimicrobial therapy on the prognosis of patients with empirical antimicrobial therapy failure.

Results

The positive rate of NGS was higher than that of conventional pathogen detection methods (92.6% vs. 74.7%, P = 0.001). Compared to the conventional group, the NGS group has a considerably higher modifications rate of antibiotic treatment (73.2% vs. 54.9%, P = 0.015). The mortality of NGS group was significantly lower than that of conventional group (28.0% vs. 43.9%, P = 0.034). Moreover, the detection of NGS can significantly shorten the ventilation time (P = 0.046), and reduce the antibiotic cost (P = 0.026).

Conclusions

NGS is a valuable tool for microbial identification of SCAP patient with initial empiric therapy failure.